Barrett’s esophagus successfully treated with MPEC ablative therapy
MedWire News: Patients with nondysplastic Barrett's esophagus (BE) can be effectively treated with multipolar electrocoagulation (MPEC) in combination with acid suppression, suggest findings from a 10-year follow-up study.
"Ablative approaches are attractive because they offer a potential alternative to long-term surveillance approaches while liberating patients from the associated worry related to diagnosis of a precancerous lesion," say Moises Guelrud (Tufts Medical Center, Boston, Massachusetts, USA) and co-authors.
In total, 166 patients, aged an average 53 years, with nondysplastic BE and histologic evidence of intestinal metaplasia underwent MPEC ablation therapy to areas of BE identified with magnificent chromoendoscopy. All patients were placed on high-dose proton pump inhibitors twice daily starting 1-2 weeks prior to ablation, during the entire treatment, and for 1 year after complete ablation.
Following complete ablation, patients were followed-up on an annual basis using magnification chromoendoscopy and biopsy. Of the patients studied, 139 completed at least 10 years of follow-up, at an average of 10.6 years.
The average length of BE was 2.56 cm, with the majority (n=114) of patients presenting short-segment BE (average 1.71 cm). Patients required one to five sessions of ablation therapy to achieve complete Barrett's eradication, with 95% of patients showing no recurrence. The average number of sessions needed was 1.7, with short-segment and long-segment BE requiring 1.3 and 3.3 sessions, respectively.
Patients who developed residual/recurrent BE after ablation had disease identified within 2 years of completing treatment, and were successfully treated with repeated ablative therapy until BE was eradicated.
No esophageal adenocarcinoma or dysplasia of any grade developed in any of the patients. In total, 11 patients died during the study, but none of the deaths was directly related to ablation therapy.
Minor complications occurred in fewer than 5% of patients, with chest pain occurring in the majority of these cases. Other complications included upper gastrointestinal bleeding, a partial asymptomatic and symptomatic mucosal ring, and dysphagia that resolved after 1 day without treatment. No patient required surgery or hospitalization.
Writing in the journal Gastrointestinal Endoscopy, the researchers conclude: "Our findings lend support for ablation by using MPEC as an option for patients with nondysplastic BE. Additional studies are needed to confirm our observations and ideally compare an ablative approach with standard surveillance."
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By Ingrid Grasmo